The natural history of hypertension in older adults: a study of two Finnish generational cohorts born 20 years apart.

BACKGROUND: We conducted a comparative analysis of hypertension prevalence, progression, and treatment in two Finnish population-based cohorts comprising older adults born 20 years apart. The study covered data from pre- and post-HYVET Study eras and spanned the onset of the COVID-19 pandemic. METHODS: All 70-year-old home-dwelling citizens of Turku, in Southwest Finland, were invited to participate in the survey in 1990 (1920-born TUVA cohort) and in 2010 (1940-born UTUVA cohort) with a 25-year follow-up plan. The analyses included those with available data for systolic and diastolic blood pressure (BP), yielding 1015 TUVA and 888 UTUVA participants at baseline. Biomarkers associated with BP were analysed with t- and chi-square tests. RESULTS: At baseline, 83.4% of TUVA and 74.3% of UTUVA participants had uncontrolled BP, with respective antihypertensive medication usage at 36.0% and 55.9% (p < .001 for both between-cohort differences). Systolic BP exhibited an inverted U-shaped trajectory, with TUVA initially 7.8 mmHg higher at 155.4 mmHg than UTUVA (p < .001). However, by the ages 80-82, the difference in systolic BP trajectories between the cohorts was attenuated to 4.0 mmHg (p = .03). Diastolic BP differences were less clinically significant. UTUVA demonstrated higher use of all five conventional antihypertensive categories than TUVA (p ≤ .02 for all categories). CONCLUSIONS: In the early years of older adulthood, the 1940-born cohort showed a positive trend in hypertension management, yet maintained a 74.3% baseline rate of uncontrolled BP. Furthermore, by the ages 81-82, the benefits observed over the 1920-born cohort had lessened, influenced by the COVID-19 pandemic or other lasting factors. Heightened efforts to improve hypertension treatment in older adults remain crucial in the post-HYVET era.

We studied two generational cohorts of older adults from Finland, born 20 years apart, to examine changes in blood pressure readings over time, the prevalence of high blood pressure, and its treatment. Our investigation spanned periods both before and after the HYVET Study, a significant research effort demonstrating the benefits of treating hypertension in older adult patients, reducing the risk of stroke and other causes of mortality. Additionally, we considered the potential impact of the COVID-19 pandemic on blood pressure control.We invited all 70-year-olds living at home in Turku, Southwest Finland, to participate in our survey in 1990 (the 1920-born cohort) and in 2010 (the 1940-born cohort), with plans to follow them for 25 years. We collected data on their blood pressure readings and the medications they were prescribed.At the outset of our study, when participants were 70 years old, a higher proportion of individuals in the 1920-born cohort had uncontrolled high blood pressure compared to those in the 1940-born group. In addition, the participants born in 1940 showed increased usage and a wider selection of antihypertensive medications compared to the 1920-born cohort. Despite this, over 70% of the 70-year-olds even in the 1940-born cohort still had uncontrolled blood pressure. Furthermore, by the time these individuals reached their early 80s, the initial improvements in blood pressure control over the 1920-born cohort had somewhat diminished.Our findings underscore the ongoing need for improvements in managing high blood pressure among older adults. This remains crucial as individuals age, emphasising the importance of continued research to develop better treatment approaches, even after landmark studies like HYVET.

Trends in Positive Life Orientation Among 70-Year-Olds: A Comparison of Two Finnish Cohorts Born 20 Years Apart.

OBJECTIVES: We assessed if positive life orientation (PLO) has increased among older individuals and explored gender disparities in PLO changes. METHODS: Two cohorts of 70-year-olds from Turku, Finland were included: the 1920 birth cohort (examined in 1991; n = 1,032) and the 1940 birth cohort (examined in 2011; n = 956). Participants completed an identical questionnaire assessing life satisfaction, feeling needed, future plans, zest for life, depression, and loneliness. A composite PLO score (range 0-1) was computed. RESULTS: The 2011 cohort had a higher mean PLO score than the 1991 cohort (.87 vs. .83, p < .001). The 2011 cohort reported higher sense of being needed, more future plans, and reduced loneliness (all p < .001). No significant differences were found in life satisfaction, zest for life, or depression. Gender disparities in PLO persisted across both cohorts, with men scoring slightly higher but following similar trends as women. DISCUSSION: PLO appears to have increased among older individuals. CLINICAL IMPLICATIONS: Recognizing the rising trend of PLO in recent decades may influence the development of societal and healthcare policies to further improve overall well-being among older individuals.

The associations of self-reported salt-intake and spot urine sodium with home blood pressure.

Purpose: A limited number of studies have suggested a nonlinear association between spot urine (SU) sodium concentration and office blood pressure (BP). We examined how SU sodium concentration and dietary salt obtained from a food frequency questionnaire are associated with more accurately measured home BP in a large, nationwide population sample.Materials and methods: We included 1398 participants in cross-sectional and 851 participants in 11-year longitudinal analyses. We investigated associations between baseline salt/sodium variables and (i) baseline and follow-up home BP; and (ii) prevalent and incident hypertension with linear and logistic regression models.Results: We observed positive associations (ß ± standard error) between salt/sodium variables and BP in unadjusted models. SU sodium concentration associated with baseline systolic (0.04 ± 0.01, p < 0.001) and diastolic (0.02 ± 0.01, p < 0.001) BP and follow-up systolic (0.03 ± 0.01, p = 0.003) and diastolic (0.02 ± 0.01, p < 0.001) BP. Dietary salt intake was associated with baseline (0.52 ± 0.19, p = 0.008) and follow-up (0.57 ± 0.20, p = 0.006) systolic BP. Compared to the lowest quintile of SU sodium concentration, the highest quintile had greater odds of prevalent hypertension (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.12-2.19) and the second highest quintile with incident hypertension (OR 1.86, 95% CI 1.05-3.34). Unadjusted odds of incident hypertension were higher in the highest as compared to the lowest quintile of dietary salt intake (OR 1.83, 95% CI 1.01-3.35). After adjustments for sex, age, plasma creatinine concentration and alcohol intake, none of the aforementioned associations remained statistically significant. We found no evidence of a J-shaped association between the salt/sodium variables and BP or hypertension.Conclusion: SU sodium concentration and dietary salt intake are associated with home BP and hypertension only in some of the unadjusted models. Our results underscore that feasible estimation of sodium intake remains challenging in epidemiology.

What is known about the topicSome studies have suggested a non-linear association between spot urine sodium and blood pressure24-hour urinary sodium sampling is the gold standard method for assessing sodium intakeWhat this study addsMultiple fractional polynomials did not reveal evidence of a J-shaped association between spot urine sodium or dietary salt intake (measured by a questionnaire) and home blood pressurePrecise and yet feasible estimation of sodium intake remains challenging in epidemiology.

Effects of Bifidobacterium animalis ssp. lactis 420 on gastrointestinal inflammation induced by a nonsteroidal anti-inflammatory drug: A randomized, placebo-controlled, double-blind clinical trial.

AIMS: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause damage to the gastric and duodenal mucosa. Some probiotics have proven useful in ameliorating the harmful side-effects of NSAIDs. Our aim was to evaluate whether oral administration of Bifidobacterium animalis ssp. lactis 420 (B420) can attenuate the increase of calprotectin excretion into faeces induced by intake of diclofenac sustained-release tablets. METHODS: A double-blind, parallel-group, placebo-controlled and randomized clinical study was performed in 50 healthy male and female volunteers aged 20-40 years, in Finland. Study participation consisted of 4 phases: run-in, intervention with B420 or placebo, B420 or placebo + NSAID treatment, and follow-up. The primary outcome was the concentration of calprotectin in faeces. Secondary outcomes were haemoglobin and microbial DNA in faeces and blood haemoglobin levels. RESULTS: Intake of diclofenac increased the faecal excretion of calprotectin in both groups. The observed increases were 48.19 ± 61.55 µg/g faeces (mean ± standard deviation) in the B420 group and 31.30 ± 39.56 µg/g in the placebo group (difference estimate 16.90; 95% confidence interval: -14.00, 47.77; P = .276). There were no significant differences between the treatment groups in changes of faecal or blood haemoglobin. Faecal B. lactis DNA was much more abundant in the B420 group compared to the placebo group (ANOVA estimate for treatment difference 0.85 × 109 /g faeces; 95% confidence interval: 0.50 × 109 , 1.21 × 109 ; P < .0001). CONCLUSIONS: Short-term administration of the probiotic B420 did not protect the healthy adult study participants from diclofenac-induced gastrointestinal inflammation as determined by analysis of faecal calprotectin levels.

Age of Hypertension Onset: Overview of Research and How to Apply in Practice.

PURPOSE OF REVIEW: To review the current evidence on research related to age of hypertension onset-its definition, correlates, heritability, and association with adverse outcomes. We also propose a framework for implementing assessment of hypertension onset age into clinical practice. RECENT FINDINGS: Prior studies have used both objective measurements and self-report to determine age of hypertension onset or early-onset hypertension. Yet, no criterion for standard definition currently exists for either. Data from epidemiological and clinical studies demonstrate that early-onset hypertension is a highly heritable trait that confers an increased risk for cardiovascular death and end-organ damage compared with late-onset hypertension. Literature to date suggests that (parental) age of hypertension onset can be feasibly assessed for estimating (1) risk of future hypertension in non-hypertensive persons; and (2) the propensity for cardiovascular disease in individuals with established hypertension.

Thyroid-stimulating hormone and risk of sudden cardiac death, total mortality and cardiovascular morbidity.

BACKGROUND: Previous data on the association of thyroid function with total mortality, cardiovascular disease (CVD) outcomes and sudden cardiac death (SCD) are conflicting or limited. We investigated associations of thyroid-stimulating hormone (TSH) with these outcomes in a nationwide population-based prospective cohort study. METHODS: We examined 5211 participants representative of the Finnish population aged ≥30 years in 2000-2001 and followed them for a median of 13.2 years. Using Cox proportional hazards regression models adjusted for baseline age, gender, smoking, diabetes, systolic blood pressure and total and high-density lipoprotein cholesterol, we assessed the associations of continuous baseline TSH and TSH categories (low [<0.4 mU/L], reference range [0.4-3.4 mU/L] and high [>3.4 mU/L]) with incident total mortality, SCD, coronary heart disease events, stroke, CVD, major adverse cardiac events and atrial fibrillation. RESULTS: High TSH at baseline was related to a greater risk of total mortality (HR 1.34, 95% CI 1.02-1.76) and SCD (HR 2.28, 95% CI 1.13-4.60) compared with TSH within the reference range. High TSH was not associated with the other outcomes (P ≥ .51), whereas low TSH was not associated with any of the outcomes (P ≥ .09). TSH at baseline over the full range did not have a linear relation with any of the outcomes (P ≥ .17). TSH showed a U-shaped association with total mortality after a restricted cubic spline transformation (P = .01). CONCLUSIONS: Thyroid function abnormalities could be linked with higher risks of total mortality and SCD. Large-scale randomized studies are needed for evidence-based recommendations regarding treatment of mild thyroid failure.

Association of thyroid-stimulating hormone with lipid concentrations: an 11-year longitudinal study.

BACKGROUND: Scant data exist on the longitudinal association between thyroid function and lipid concentrations. We investigated associations of TSH and lipid concentrations cross-sectionally and longitudinally in a nationwide population sample. METHODS: A total of 5205 randomly sampled participants representative of Finns aged ≥30 years were examined in 2000-2001 and included in cross-sectional analyses. A total of 2486 were re-examined 11 years later and included in longitudinal analyses. With linear regression models adjusted for age, gender, smoking and body mass index, we assessed the associations of baseline TSH and TSH categories (low, reference range and high) with total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol; apolipoprotein A1 and B; and triglycerides at baseline and follow-up. RESULTS: At baseline, higher TSH associated with higher total cholesterol (ß = 0·025, standard error [SE] = 0·007, P < 0·001), LDL cholesterol (ß = 0·020, SE = 0·007, P = 0·002), apolipoprotein B (ß = 0·006, SE = 0·002, P < 0·001) and log triglycerides (ß = 0·008, SE = 0·003, P = 0·004), but not with other lipid outcomes. Higher baseline TSH associated with higher total cholesterol (ß = 0·056, SE = 0·026, P = 0·033), LDL cholesterol (ß = 0·057, SE = 0·023, P = 0·015) and apolipoprotein B (ß = 0·012, SE = 0·006, P = 0·028) at follow-up in women, but not with any lipid outcomes in men. Participants with high TSH at baseline had a 0·22 mmol/l (95% confidence interval 0·02-0·41 mmol/l) higher LDL cholesterol at follow-up (P = 0·028) than participants with TSH in the reference range (0·4-3·4 mU/l). However, exclusion of participants with high-risk baseline lipid values rendered these positive longitudinal associations nonsignificant (P ≥ 0·098). CONCLUSIONS: We could confirm a modest association between higher TSH and an adverse lipid profile cross-sectionally but not indisputably longitudinally.

Incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities - a nationwide population-based study.

BACKGROUND: Scant data exist on incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities in the general population. METHODS: We recorded ECG and measured conventional cardiovascular risk factors in 5667 Finns who were followed up for incident atrial fibrillation (AF). We obtained repeat ECGs from 3089 individuals 11years later. RESULTS: The incidence rates of prolonged P-wave duration, abnormal P terminal force (PTF), left P-wave axis deviation, and right P-wave axis deviation were 16.0%, 7.4%, 3.4%, and 2.2%, respectively. Older age and higher BMI were associated with incident prolonged P-wave duration and abnormal PTF (P≤0.01). Higher blood pressure was associated with incident prolonged P-wave duration and right P-wave axis deviation (P≤0.01). During follow-up, only prolonged P-wave duration predicted AF (multivariable-adjusted hazard ratio, 1.38; P=0.001). CONCLUSIONS: Modifiable risk factors associate with P-wave abnormalities that are common and may represent intermediate steps of atrial cardiomyopathy on a pathway leading to AF.

Association between thyroid-stimulating hormone and blood pressure in adults: an 11-year longitudinal study.

BACKGROUND: The results of longitudinal studies on the association between thyroid function and blood pressure (BP) are divided. This study aimed to investigate this association in cross-sectional and longitudinal settings in a nationwide, random sample representative of the Finnish adult population aged 30 and over. METHODS: The study sample was randomly drawn from the population register. A total of 5655 participants were included in the baseline analyses and 3453 in the 11-year prospective analyses. The associations between baseline TSH and (i) BP and BP change over time; and (ii) prevalent and incident hypertension were assessed using linear and logistic models, adjusted for age, gender, smoking and body mass index. RESULTS: A positive association (ß ± standard error) was observed between TSH and diastolic (0·36 ± 0·12, P = 0·003) but not systolic BP (0·16 ± 0·21, P = 0·45) at baseline. TSH was negatively associated with 11-year BP change in men (systolic: -0·92 ± 0·41, P = 0·03; diastolic: -0·66 ± 0·26, P = 0·01) but not in women (P ≥ 0·09 for systolic and diastolic BP change). Participants in the highest TSH tertile within the TSH reference interval (0·4-3·4 mU/L), as compared with the lowest, had increased odds of prevalent (odds ratio 1·22, 95% confidence interval 1·05-1·43, P = 0·01) but not incident hypertension (odds ratio 0·93, 95% confidence interval 0·73-1·19, P = 0·58). CONCLUSIONS: A modest association was found between increasing TSH and prevalent but not incident hypertension. TSH was inversely associated with BP change in men in our study. These findings contest an independent role of thyroid function at normal to near-normal levels in the pathogenesis of hypertension.

Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample.

BACKGROUND: Previous studies with mainly selected populations have proposed contradicting reference ranges for thyroid-stimulating hormone (TSH) and have disagreed on how screening, age and gender affect them. This study aimed to determine a TSH reference range on the Abbott Architect ci8200 integrated system in a large, nationwide, stratified random sample. To our knowledge this is the only study apart from the NHANES III that has addressed this issue in a similar nationwide setting. The effects of age, gender, thyroid peroxidase antibody (TPOAb)-positivity and medications on TSH reference range were also assessed. METHODS: TSH was measured from 6247 participants randomly drawn from the population register to represent the Finnish adult population. TSH reference ranges were established of a thyroid-healthy population and its subpopulations with increasing and cumulative rigour of screening: screening for overt thyroid disease (thyroid-healthy population, n=5709); screening for TPOAb-positivity (risk factor-free subpopulation, n=4586); and screening for use of any medications (reference subpopulation, n=1849). RESULTS: The TSH reference ranges of the thyroid-healthy population, and the risk factor-free and reference subpopulations were 0.4-4.4, 0.4-3.7 and 0.4-3.4 mU/L (2.5th-97.5th percentiles), respectively. Although the differences in TSH between subgroups for age (p=0.002) and gender (p=0.005) reached statistical significance, the TSH distribution curves of the subgroups were practically superimposed. CONCLUSIONS: We propose 0.4-3.4 mU/L as a TSH reference range for adults for this platform, which is lower than those presently used in most laboratories. Our findings suggest that intensive screening for thyroid risk factors, especially for TPOAb-positivity, decreases the TSH upper reference limit.

Oral Anticoagulant Therapy and Risk of Admission to Long-Term Care in patients With Atrial Fibrillation: A Nationwide Cohort Study.

OBJECTIVES: The impact of oral anticoagulants (OACs) on the need of long-term care (LTC) in the aging and multimorbid population of patients with atrial fibrillation (AF) is unknown. We conducted a nationwide cohort study to evaluate the effect of OACs on the need of LTC. DESIGN: Retrospective nationwide cohort study. SETTING AND PARTICIPANTS: The registry-based FinACAF cohort study covers all patients with incident AF from all levels of care in Finland from 2007 to 2018, as well as all their OAC purchases, LTC admissions, and information on previous home care acuity. METHODS: Incidence rate ratios (IRRs) of LTC admission were calculated using Poisson regression models with a Lexis-type data structure based on 3 time scales: follow-up time from AF diagnosis, calendar year, and age. RESULTS: We identified 188,752 patients (49.0% female; mean age 71.4 years; mean follow-up 3.6 years) with incident AF without prior LTC, of whom 143,534 (76.0 %) initiated OAC therapy and 11,775 (6.2 %) were admitted to LTC. OAC therapy was associated with lower rates of LTC admission (adjusted IRR 0.79, 95% CI 0.76-0.82). When compared to warfarin, direct oral anticoagulants (DOACs) were associated with lower LTC admission rate (adjusted IRR 0.69, 95% CI 0.61-0.79). No significant disparities were observed between different DOACs. CONCLUSIONS AND IMPLICATIONS: OAC therapy, particularly with DOACs, is associated with a substantially lower risk of admission to LTC in patients with AF. Increasing guideline-based OAC coverage among patients with AF may prevent the need of LTC, lengthen survival at home, and potentially decrease health care costs.

Rural-urban differences in the initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

AIMS: Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence. METHODS: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The outcome was the first redeemed OAC prescription. RESULTS: We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007-2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95-0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93-0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence. CONCLUSION: This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use.

Longitudinal blood pressure patterns and cardiovascular disease risk.

Observational and interventional studies have unequivocally demonstrated that "present", i.e. single-occasion, blood pressure is one of the key determinants of cardiovascular disease risk. Over the past two decades, however, numerous publications have suggested that longitudinal blood pressure data and assessment of long-term blood pressure exposure provide incremental prognostic value over present blood pressure. These studies have used several different indices to quantify the overall exposure to blood pressure, such as time-averaged blood pressure, cumulative blood pressure, blood pressure trajectory patterns, and age of hypertension onset. This review summarises existing research on the association between these indices and hard cardiovascular outcomes, outlines the strengths and weaknesses of these indices, and provides an overview of how longitudinal blood pressure changes can be measured and used to improve cardiovascular disease risk prediction.KEY MESSAGESNumerous recent publications have examined the relation between cardiovascular disease and long-term blood pressure (BP) exposure, quantified using indices such as time-averaged BP, cumulative BP, BP trajectory patterns, and age of hypertension onset.This review summarises existing research on the association between these indices and hard cardiovascular outcomes, outlines the strengths and weaknesses of these indices, and provides an overview of how longitudinal BP changes can be measured and used to improve cardiovascular disease risk prediction.Although longitudinal BP indices seem to predict cardiovascular outcomes better than present BP, there are considerable differences in the clinical feasibility of these indices along with a limited number of prospective data.

Usability of two brief questions as a screening tool for domestic violence and effect of #MeToo on prevalence of self-reported violence.

OBJECTIVE: Domestic violence is a hidden epidemic. We used a two-question screening tool to explore the prevalence of domestic violence among gynaecological outpatients. We also retrospectively assessed whether there was a change in the prevalence rate of self-reported violence after the launch of the #MeToo movement. STUDY DESIGN: Over an 11-month period, all gynaecological first-time visitors to our outpatient clinic were asked two dichotomous questions that screened for domestic violence and examined whether the violence had an ongoing impact on the respondent's everyday life. We used logistic regression models to assess whether the launch of #MeToo was associated with the answers to these two questions. RESULTS: Of the 6,957 screened women, 154 (2.2 %) tested positive for domestic violence. Among the screen-positive women, 87 (56.5 %) reported that the violence affected their health and well-being. Of these 87 women, 52.9 % wanted further support and 72.4 % had already contacted psychiatric care. Out of all of the patients, the proportion of screen-positive respondents was 2.3 % before and 2.2 % after #MeToo. We did not detect increased odds of self-reporting domestic violence (odds ratio 0.97, 95 % confidence interval 0.70-1.36) or its ongoing impact on the victim's everyday life (odds ratio 1.05, 95 % confidence interval 0.53-2.07) after #MeToo. CONCLUSIONS: Our two-question screening tool detected a lower prevalence of domestic violence among gynaecological outpatients than previous reports examining the general population. Our results illustrate the dire challenges in screening for domestic violence that persist even in the post-#MeToo era. Domestic violence remains a highly intimate, stigmatising, and underreported health issue, and systematic measures to screen for and prevent it should be advocated, both in gynaecological patients and the general population.

Electrocardiographic predictors of atrial fibrillation in nonhypertensive and hypertensive individuals.

OBJECTIVE: The aim of this study was to compare the predictive value of ECG abnormalities for atrial fibrillation in nonhypertensive versus hypertensive individuals. METHODS: We recorded ECG and measured conventional cardiovascular risk factors in a nationwide population-based sample of 5813 Finns. We divided the participants into nonhypertensive (n = 3148) and hypertensive (n = 2665) individuals and followed the participants for incident atrial fibrillation events. We evaluated the predictive ability of 12 ECG abnormalities for atrial fibrillation using multivariable-adjusted Fine-Gray models. RESULTS: During a follow-up of 11.9 ±â€Š2.9 years, 111 nonhypertensive and 301 hypertensive participants developed atrial fibrillation. Negative T wave in lateral leads predicted atrial fibrillation in both nonhypertensive [hazard ratio (HR), 4.59; 95% confidence interval (95% CI) 1.84-11.44] and hypertensive participants (HR, 1.81; 95% CI 1.16-2.84). In nonhypertensive participants, 1-SD increments in corrected QT interval (HR, 1.42; 95% CI, 1.18-1.71) and T-wave amplitude in lead augmented vector R (aVR) (HR, 1.40; 95% CI, 1.10-1.80) were related to atrial fibrillation. In hypertensive participants, prolonged PR interval (HR, 1.59; 95% CI 1.05-2.41), prolonged P-wave duration (HR, 1.43; 95% CI 1.07-1.91), left ventricular hypertrophy by Sokolow-Lyon criteria (HR, 1.55; 95% CI, 1.12-2.14) and poor R-wave progression (HR, 1.59; 95% CI, 1.02-2.48) predicted atrial fibrillation. Corrected QT interval and T-wave amplitude in lead aVR were stronger predictors of atrial fibrillation in nonhypertensive than in hypertensive participants. ECG abnormalities improved risk prediction only marginally (delta area under receiver-operating-characteristic curve = 0.000-0.005). CONCLUSION: Several ECG abnormalities associate with incident atrial fibrillation in hypertensive and nonhypertensive individuals but provide only marginal incremental predictive value. Corrected QT interval and T-wave amplitude in lead aVR may relate stronger to incident atrial fibrillation in nonhypertensive than in hypertensive individuals.

Relation of blood pressure and organ damage: comparison between feasible, noninvasive central hemodynamic measures and conventional brachial measures.

OBJECTIVE: The present cross-sectional study investigated whether central SBP and pulse pressure (PP) measured noninvasively with a novel cuff-based stand-alone monitor are more strongly associated with hypertensive end-organ damage than corresponding brachial measures. METHODS: We investigated the cross-sectional association of central versus brachial SBP and PP with echocardiographic left ventricular mass index (LVMI), LV hypertrophy (LVH), carotid intima-media thickness (IMT), and increased IMT (IMT ≥ 75th percentile) among 246 participants drawn from the general population (mean age 57.2 years, 55.3% women). RESULTS: All blood pressure (BP) measures were positively correlated with LVMI and IMT (P < 0.001 for all). Brachial and central SBP correlated equally strongly with LVMI (r = 0.42 versus 0.40, P for difference 0.19) and IMT (r = 0.32 versus 0.33, P = 0.60). However, brachial PP correlated more strongly than central PP with LVMI (r = 0.34 versus 0.27, P = 0.03) and IMT (r = 0.40 versus 0.35, P = 0.04). In multivariable-adjusted logistic models, all four BP measures were significantly associated with LVH and increased IMT (P ≤ 0.03 for all). However, the diagnostic accuracy of logistic regression models that included brachial or central hemodynamic parameters was similar for LVH [area under curve (AUC) for SBP: 0.74 versus 0.76, P = 0.16; AUC for PP: 0.75 versus 0.73, P = 0.35] and IMT (AUC for SBP: 0.61 versus 0.61, P = 0.67; AUC for PP: 0.63 versus 0.61, P = 0.29). CONCLUSION: Our findings suggest that central SBP and PP measured with a stand-alone noninvasive BP monitor do not improve diagnostic accuracy for end-organ damage over corresponding brachial measures.

Home versus office blood pressure: longitudinal relations with left ventricular hypertrophy: the Finn-Home study.

OBJECTIVES: Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patient's initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent. METHODS: We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ±â€Š7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up. RESULTS: Pearson's correlation coefficients between changes in home/office SBP and changes in Sokolow-Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17, 0.25/0.16, and 0.32/0.20, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steiger's z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement. CONCLUSION: Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

Outcome-Driven Thresholds for Increased Home Blood Pressure Variability.

Increased blood pressure (BP) variability predicts cardiovascular disease, but lack of operational thresholds limits its use in clinical practice. Our aim was to define outcome-driven thresholds for increased day-to-day home BP variability. We studied a population-based sample of 6238 individuals (mean age 60.0±12.9, 56.4% women) from Japan, Greece, and Finland. All participants self-measured their home BP on ≥3 days. We defined home BP variability as the coefficient of variation of the first morning BPs on 3 to 7 days. We assessed the association between systolic/diastolic BP variability (as a continuous variable and in deciles of coefficient of variation) and cardiovascular outcomes using Cox regression models adjusted for cohort and classical cardiovascular risk factors, including BP. During a follow-up of 9.3±3.6 years, 304 cardiovascular deaths and 715 cardiovascular events occurred. A 1 SD increase in systolic/diastolic home BP variability was associated with increased risk of cardiovascular mortality (hazard ratio, 1.17/1.22; 95% confidence interval, 1.06-1.30/1.11-1.34; P=0.003/<0.0001) and cardiovascular events (hazard ratio, 1.13/1.14; 95% confidence interval, 1.05-1.21/1.07-1.23; P=0.0007/0.0002). Compared with the average risk in the whole population, risk of cardiovascular deaths (hazard ratio, 1.66/1.84; 95% confidence interval, 1.27-2.17/1.42-2.37; P=0.0002/<0.0001) and events (hazard ratio, 1.46/1.42; 95% confidence interval, 1.21-1.76/1.17-1.71; P<0.0001/0.0004) was increased in the highest decile of systolic/diastolic BP variability (coefficient of variation>11.0/12.8). Increased home BP variability predicts cardiovascular outcomes in the general population. Individuals with a systolic/diastolic coefficient of variation of day-to-day home BP >11.0/12.8 may have an increased risk of cardiovascular disease. These findings could help physicians identify individuals who are at an increased cardiovascular disease risk.